June 28th, 2013

Colonoscopy Preps: Patient Marketing vs. Patient Quality

There are innumerable bowel preps on the market as well as “home brewed” ones (e.g. Miralax™ and Gatorade™). In my community, many gastroenterology practices appear to choose their colonoscopy prep based on patient acceptability and/or taste preference. I find this choice of bowel prep based on “marketing” to patients troublesome.

Although I absolutely understand the issues of patient satisfaction (I have had two colonoscopy preps), the reality is that the quality of the bowel prep directly correlates with detection of polyps and, thus, ultimately affects the ability of colonoscopy to protect against colon cancer.

In my experience, if patients are given the choice between a bowel prep that tastes good or is easier to use and the “best” one for cleaning the colon (a split-dose, PEG-based prep) and optimizing polyp detection, they will choose the latter. Frankly, I think that the use of any less optimal prep should be accompanied with documentation that the patient is aware of the “risk” associated with use of the alternate prep (missed polyps, possible increased risk for later cancer, need for another colonoscopy earlier than usual, etc.)

So, what is your approach to this issue? Specifically, I am wondering the following:

1)    How do you choose bowel preps in your practice?

2)    If you choose anything other than split-dose, PEG-based preps, do you inform patients that they may have a greater risk for missed polyps?

3)    Do you track bowel prep quality as a quality measure in your practice?

4)    In patients with a suboptimal prep, when do you reschedule them back?

I look forward to the conversation.

2 Responses to “Colonoscopy Preps: Patient Marketing vs. Patient Quality”

  1. ameer says:

    I usually use split dose PEG solution for the majority of my patients.i always write down in the report how the prep was . if the prep was not fair ,I usually repeat the exam in a month with more diet restriction and sometimes with double dose of the prep, perhaps even withen shorter time if the patient high index of suspicion for CA.

  2. Linda A. says:

    I am a colonoscopy patient and have had many polyps removed, incldg sessile serrated adenoma, etc. but no maligs yet. i have 2 concerns:

    1. why doesn’t my dr/endoscopist ever discuss the findings and location etc after the procedure? they just say “NO CANCER”. I usually call for all records including op and path repts to see what goes on. my last test i had a right prox flat adenoma which dr didn’t think he got all so i have to repeat 1 yr. do gastros commonly think patients don’t want details?

    2. i don’t like split dose because i do procedure early am and after taking 2nd dose im afraid i will have an “accident” in the taxi to facility.

    Any comments on above would be much appreciated.

Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD


NEJM Journal Watch Gastroenterology

Biography | Disclosures | Summaries

Learn more about Gut Check on Gastroenterology.